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Phar 504 > Inflammatory Bowel Disease 2 > Flashcards

Inflammatory Bowel Disease 2 Flashcards

1
Q

What drug is not approved for IBD but used for steroid sparing as a maintenance agent

A

Azathioprine

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2
Q

What is azathiprine a prodrug for in IBD, what are the hepatotoxic metabolites

A

Thioguanine nucleotide (6-TGN), methylmercaptapurine and methylmercaptopurine nucleotides

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3
Q

What are the serious side effects of Azathioprine

A

Hepatotoxicity (6-MMP), Bone Marrow Suppresion (6-TGN), lymphoma

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4
Q

How does the risk of lymphoma increase with azathioprine

A

TNF-alpha blockers used simultaneously

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5
Q

What should be monitored at the start of azaththioprine therapy for IBD, what are the levels that should lead to complete avoid or reduced dose

A

TPMT enyzme activity, less than 4 nmol/hour/ml RBCs (azathioprine should be avoided), between 4 and 12 nmol/hour/ml RBCs (dose should be cut in half)

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6
Q

What should be monitored during therapy use of azathioprine

A

CBC, LFTs weekly for 1 month, monthly for 3 months, then every 3 months

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7
Q

What is the MOA methotrexate, how can thismedication be taken

A

inhibit DNA synthesis, targets actively proliferative tissue, anti-inflammatory activity/ IM, SC or by mouth weekly

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8
Q

What must be given in conjunction with methotrexate

A

one gram of Folic acid

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9
Q

What should be monitored when taking methotrexate

A

CBC,LFTs weekly for 1 month, monthly for three months, then every 3 months

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10
Q

When treating IBD when is azathioprine avoided, methotrexate

A

in young males, women of childbearing potential

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11
Q

When should cyclosporine and tacrolimus be used in IBD

A

reserved for severe, treatment-refractory colitis (primarily UC)

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12
Q

When should antibiotics be used in IBD

A

as adjunctive therapy when there is a bacterial infection

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13
Q

What are the two antibiotics that can be taken for IBD, What are severe adverse effects that come from each drug and what triggers them

A

Metronidazol: Disulfiram reaction when used with alcohol, ciprofloxacin: tendon rupture in patients on high dose steroids

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14
Q

What are the Anti-TNF-alpha biologics used in IBD

A

Infliximab/Remicade, Adalimumab/Humira, Certolizumab/Cimzia, Golimumab/Simponi

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15
Q

Which Anti-TNF-alpha biologic can be used for Ulcerative Colitis and Crohn’s Disease

A

Infliximab and Adalimumab

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16
Q

Which Anti-TNF- alpha biologic can be used for only Ulcerative Colitis, only Crohn’s Disease

A

Golimumab, Certolizumab

17
Q

Which Anti-TNF-alpha biologic is strictly IV

A

Remicade

18
Q

What is the black box warning for Anti-TNF-alpha biologics

A

increased risk of lymphoma when used in conmitant therapy with immunomodulator, nonhodkin’s lymphoma, melanoma

19
Q

T/F: Anti-TNF-alpha can worsen congestive heart failure

A

True

20
Q

What should be monitored before using antt-TNF-alpha biologics

A

Quantiferons, Hep B, CBC, LFT, TB

21
Q

What should be monitored when using anti-TNF-alpha biologics

A

drug levels and anti-drug antibodies

22
Q

What are primary non responders anti-TNF-alpha therapy

A

Not responsive to therapy, 60% more responsive after switching to a different anti-TNF-alpha biologic

23
Q

What are secondary non responders in anti-TNF-alpha biologics

A

Were responsive at first but are no longer responsive, most likely to be creating antibodies

24
Q

When is anti-TNF-alpha biologics in combination with immunomodulators the first line of therap

A

in moderate to severe Crohn’s Disease

25
Q

What are the leukocyte adhesion inhibitors used in IBD, route of administration for both

A

Entyvio/Vedolizumab and Tysabri/Natalizumab, IV

26
Q

Which leukocyte adhesion inhibitor is used for both Crohn’s disease and Ulcerative Colitis, which leukocyte inhibitor only works on one disease, what disease

A

Vedolizumab, Natalizumab: Crohn’s Disease

27
Q

Which leukocyte adhesion inhibitor has a BBW, what is it

A

Natalizumab: progessive multifocal leukoencephalopathy (PML)

28
Q

What is the Anti-IL-12/IL-23 biologic, what disease does it affect how it it dosed

A

Ustekinumab, only Crohn’s Disease, IV loading dose and SC maintenance dose

29
Q

T/F: Ustekinumab has CYP interactions

A

True

30
Q

What Janus Kinase inhibitor is approved for IBD, route of administration, which disease

A

Tofacitinib, oral, Ulcerative colitis

31
Q

What should be monitored before tofacitinib

A

CBC,lipids,TB, Hep B, Herpes zoster

Phar 504 (34 decks)

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